Sunday, August 5, 2007

Survive the Trip to Survive the Ride

All around the country, (all around the world even) riders are making preparations for Paris Brest Paris. We’re checking off our check lists, inspecting tires, inventing cue sheets, and otherwise completing plans that have been in the works for months or even years.

Imagine an injury that could take you out of this ride, even before the start; an injury that you could incur just by laying around. Scoot a little closer to the monitor, I’ll tell you about something that could lay you out for weeks, or months, and give you a few tips on how to avoid this debilitating injury.

When someone mentions blood clots in the legs, what comes to mind? That little old lady in the support hose nudging her shopping cart along in the grocery store right? Well that’s typically Thrombophlebitis, or clotting in the superficial veins of the leg. It is common enough but not the injury you are at risk for.

What is DVT?
Deep Vein Thrombosis or DVT is an entirely different condition. Are you athletic? Do you participate in endurance activities? Do you have a trip (plane, train, car, or bus) of over 4 hours planned? If so, you are at risk of DVT.

A DVT is a blood clot (thrombus) that develops in a deep vein, usually in the lower leg. DVT can cause pain in the leg and can lead to life threatening complications. Seriously! Though they usually occur in the leg, a DVT can occur elsewhere, such as in the arm. When blood clots outside a blood vessel it is a normal process which protects the body against losing blood, but if the blood clots inside a vessel, as with DVT, it can lead to very serious complications.

In most cases of DVT the clots are small and do not cause any symptoms. The body is able to gradually break down the clot and there are no long-term effects. Larger clots may partially or totally block the blood flow in the vein. Symptoms can include swelling of the calf, pain in the calf or thigh, or calf pain that is noticeably worse when standing or walking.

One rider I know who was afflicted with DVT mentioned that he thought the pain was a really bad cramp that just would not go away. In typical rando style, he rode on and finished a challenging 300K brevet! And this is a typical scenario; most riders never heard of DVT and think of themselves as immune to something like blood clots. We're healthy right? We don't get stuff like that!

What’s worse, DVT can easily result in a Pulmonary Embolism (PE). A PE occurs when a clot breaks loose in a vein and later lodges in the lungs. Symptoms of pulmonary embolism include difficulty breathing, or the sensation that breathing is not effective (feels like you are not getting enough oxygen), pain when breathing, or weakness and fainting. A pulmonary embolism can be fatal! Emergency treatment is essential.

Who is at risk?
There are many potential causes of DVT including but not limited to:
· Age – people over 40 are at greater risk of DVT
· A past or family history of DVT
· Immobility
· Obesity
· Recent surgery or an injury, especially to the hips or knees

But there is emerging evidence that other factors may play an important role in the development of this condition. There is evidence of an elevated risk of DVT associated with air travel, or any long duration travel. The risk increases as a result of prolonged immobility, which can occur during any form of long distance travel lasting four hours or more. Generally the risk of developing DVT when traveling is very small unless one or more other risk factors is present.

One of the big problems with DVT is that it can be difficult to diagnose. Additionally many physicians will be thrown off by an athlete’s or young person’s apparent good health. This is one situation where your physical fitness and athletic life style may actually work against you. Remeber the lady in the grocery store? Doctors have blind spots too! A tragic case occurred in Scotland in 2003, when a 23 year old physical therapy student feared she had DVT symptoms but was unable to convince doctors to run appropriate tests. She died of a PE.

On long distance flights, people are required to sit in the same seat for long periods of time (often more than four hours at a time). For example, flights from the US to Europe range from 5 hours from the east coast to 9 or more hours from the west coast. This can cause the blood flow in the veins in the leg to slow down, and may promote the formation of blood clots.

Research published in 2003 suggests that up to 10% of all long distance air travelers had shown signs of raised levels of clot-forming proteins in their blood. These people did not show physical signs of having blood clots, but the raised protein levels indicate that they may be at increased risk of forming clots. As I mentioned earlier, this problem is not restricted to air travel. Long distance travel by car, bus, or train can also set the stage for DVT.

If you are athletic and you travel, it just gets worse. Approximately 85% of air travel thrombosis victims are athletic, usually endurance type athletes like marathoners and cyclists. 85%! That’s huge! People with slower resting heart rate (think slower blood flow) are at greater risk of stasis, stagnant blood subject to clotting. Also, they are more likely to have bruises and sore muscles that can trigger clotting. No other risk factor comes close to this. Although age over 60 is a risk factor, these athletic victims are younger, 82% of them are under 60. Does this sound like you? Are you athletic? Are you under 60? Is there a long distance trip in your near future? If so, listen up, there are things you can and should do to lessen the risk.

Prevention techniques
If there is a long distance trip in your future, here are a few things you can do to reduce the risk of developing DVT:
· Avoid sitting for long periods.
· Move around the plane during the flight.
· If you are driving, stop and take a break.
· Exercise your legs even if you are seated.
· Frequently change positions in your seat.
· Stay hydrated while in flight – drink sufficient water or liquids.
· Seek your doctors’ advice before flying if you have any medical condition that is a known risk factor for DVT.

Flex your legs at fifteen minute intervals during travel, and whenever possible walk around the aircraft. If other risk factors are present, such as a personal or family history of clots, more frequent flexing is advisable as well as wearing compression stockings. Avoid sleeping, alcohol, and sleeping pills.

Compression stockings? Avoid alcohol? What’s next; using Ensure for nourishment? Oh right, you are already doing that. The point is, this is a very real threat and though some of these preventive therapies may seem an inconvenience to your rando life style or perhaps a little embarrassing, they could save your ride, and maybe a lot more. The one thing you can do that is most likely to protect you is to get your head right. Don’t think that because you put in 150 mile weeks year round that you are immune, in fact it is precisely because you are so fit that you are at elevated risk. You’re not immune, you are at risk!

This isn’t just world class athletes we are talking about. I personally know three riders in our club who have suffered this crippling affliction. In all three cases the riders were in their 30’s and 40’s, all were very fit and active and none of them had ever even heard of DVT.

I don’t know about you, but I’ll be up and down the aisle on that flight to Paris. I’ll be drinking plenty of water and stretching and flexing my legs frequently.

Bonne route and Bonne Chance!

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